Match: How students can flip the script during residency interviews

As a medical student, your approach to residency interviews should come with a plan on how to respond to certain questions as well as a plan about which questions to ask.

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A recent presentation by two current residents who went through the Match process in 2018 offered some tips on a proactive approach that allows interviewees to flip the script during the interview process.

Amarpreet Ahluwalia, MD, and Kaitlyn Shank, MD, former classmates at the Penn State College of Medicine, one of the 37 member schools of AMA’s Accelerating Change in Medical Education Consortium, offered this guidance for medical students on residency interviews during the ChangeMedEd® 2019 national conference, an event convening more than 500 innovators and experts in medical education to transform the way future physicians are trained.

Understand your motivators

The presentation cited Herzberg’s dual-factor theory. This theory states that people need to have an environment that allows them to pursue their motivating factors, such as personal growth and recognition, as well as the hygiene factors, such as work conditions and relationships with colleagues, to achieve a fulfilling career in a sustainable work environment.

In terms of the motivating factors, both Drs. Ahluwalia and Shank wanted to find residency programs that had a curriculum that extended Penn State’s focus on health systems science, the third pillar of medical education that complements the traditional pillars of basic and clinical science. Having an awareness of their motivators affected how they researched programs and the types of questions they asked during interviews.

“So, as we started we said, OK, let's start really, really low level and ask: Does the program have any awareness of health systems science at all?” said Dr. Ahluwalia, now a first-year internal medicine resident at Johns Hopkins Bayview Medical Center.

“Then we began to get a little more nuanced, and we said, OK, beyond that base level … what infrastructure do they have?” Dr. Ahluwalia added. “What does this culture look like? How transparent are they? How aware are they of their own shortcomings as a system and what are they doing to address that? And what are my opportunities for growth as a learner and clinician?”

This approach, in a sense, works backwards. The questions you ask on interview day will focus on the things that motivate you and will ultimately make your fit in a program a successful one.

“When you're designing a question, you really need to know why you're asking what you're asking and to get a sense of what the themes are that create the culture you're trying to enter into,” said Dr. Shank, now a first-year resident in Harvard’s combined medicine-pediatrics program at Brigham & Women’s Hospital and Boston Children’s Hospital.

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Know your audience

During your interview, you’re not going to have much time. To mitigate that, both presenters recommended knowing all the minor details of the program going into an interview, thus allowing an interviewee to have more focused questions.

“When we got to the interview day, we were surprised to find just how limited we were during the day to get a sense of the culture,” said Dr. Shank. “We found that it was very important to not only ask good questions that elicited very strong and comprehensive answers that give us a better sense of the culture, but also that we had to be asking the right person.

“Often times we would ask a question about QI [quality improvement] to someone who really didn't know anything about that in the hospital,” Dr. Shank added. “And if that was our takeaway we thought that there really was no infrastructure. So, we had to push ourselves to ask broader questions to a bigger audience and to make sure we were asking the right people.”

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Keep questions open ended

Drs. Shank and Ahluwalia were intrigued to uncover how much emphasis specific residency programs put on quality and safety. Their initial question to get at that topic was “Can you describe the culture of safety at this institution?” As residency interviews went on, they reframed the question to “Can you tell me a story that you feel best illustrates strengths and opportunities for growth at this institution?”

“That brought us an abundance of information,” Dr. Shank said. “During one encounter I can recall, I'd asked that question, and they talked a bit about the nursing staff in their ICU and how they had recognized errors that were being made and they had spoken up and they'd come up with an initiative and worked with the house staff to try to improve that system and the errors have then been divulged to the hospital and the rates of errors in that realm have gone down. … That told me a lot more by asking it that way and leaving it open ended.”